https://doi.org/10.30702/Ophthalmology30092020-11.1.1723-31

 Zavoloka O. V.¹, Bezditko P. А.¹, Karliychuk М. А.²

¹Kharkiv National Medical University, Kharkiv, Ukraine
²Bukovinian State Medical University, Chernivtsi, Ukraine

Effectiveness of Treatment of Bacterial Keratitis in Diabetes Patients Depending on the Severity of Diabetic Polyneuropathy

Abstract

The aim of the study was to identify the features of bacterial keratitis in patients with diabetes mellitus, depending on the severity of diabetic polyneuropathy in complex treatment with eye drops which contain alpha-lipoic acid, citicoline, cyanocobalamine and hyaluronic acid.

Materials and methods. 15 patients with type 1 diabetes mellitus and bacterial keratitis were observed. Ophthalmological examination except of standard methods, included bacteriological examination, fluorescein test, noncontact corneal esthesiometry. All patients were treated with instillations of the antibiotic ofloxacin, standard anti-inflammatory therapy, and instillations of eye drops Tioretin A and OMK 2 twice a day locally. Observations were made on the first, third, seventh, tenth, fourteenth, eighteenth and twenty-second days.

Results and discussion. In all periods of observation, the severity of conjunctival hyperemia and corneal edema, as well as the size of corneal erosion at the stage of severe complications diabetic polyneuropathy exceeded the corresponding rates of patients with asymptomatic and symptomatic degree. Normalization of conjunctiva color, reepithelialization of the cornea and disappearance of corneal opacification in all patients with severe complications diabetic polyneuropathy occurred 4 days later than in patients with asymptomatic and symptomatic degree.

Conclusions. The course of bacterial keratitis depends on the severity of diabetic polyneuropathy: more pronounced violation of corneal innervation is marked at the stage of severe complications diabetic polyneuropathy, which manifested by decrease in its sensitivity, and led to the prolongation of the disease.

Keywords: diabetes mellitus, bacterial keratitis, diabetic polyneuropathy, alphalipoic acid, citicoline, cianocobalamine, corneal reepitalisation.

REFERENCES

1. Vieira-Potter VJ, Karamichos D, Lee DJ. Ocular complications of diabetes and therapeutic approaches. Biomed Res Int. 2016;2016:3801570. https://doi.org/10.1155/2016/3801570
2. Wang B, Yang S, Zhai HL, Zhang YY, Cui CX, Wang JY, Xie LX. A comparative study of risk factors for corneal infection in diabetic and non-diabetic patients. Int J Ophthalmol. 2018 Jan 18;11(1):43-7. https://doi.org/10.18240/ijo.2018.01.08
3. Grzybowski A, Kanclerz P, Huerva V, Ascaso FJ, Tuuminen R. Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J Clin Med. 2019 May 20;8(5):716. https://doi.org/10.3390/jcm8050716
4. Kaji Y. Prevention of diabetic keratopathy. Br J Ophthalmol. 2005 Mar;89(3):254-5. https://doi.org/10.1136/bjo.2004.055541
5. Davidson EP, Coppey LJ, Shevalye H, Obrosov A, Kardon RH, Yorek MA. Impaired corneal sensation and nerve loss in a type 2 rat model of chronic diabetes is reversible with combination therapy of menhaden oil, α-lipoic acid, and enalapril. Cornea. 2017 Jun;36(6):725-31. https://doi.org/10.1097/ICO.0000000000001182
6. Cagini C, Leontiadis A, Ricci MA, Bartolini A, Dragoni A, Pellegrino RM. Study of alphalipoic acid penetration in the human aqueous after topical administration. Clin Exp Ophthalmol. 2010 Aug;38(6):572-6. https://doi.org/10.1111/j.1442-9071.2010.02319.x
7. Ekinci M, Cagatay HH, Ceylan E, Keles S, Koban Y, Gokce G, Huseyinoğlu U, Ozcan E, Oba ME. Reduction of conjunctival fibrosis after trabeculectomy using topical α-lipoic acid in rabbit eyes. J Glaucoma. 2014 Aug;23(6):372-9. https://doi.org/10.1097/IJG.0000000000000052
8. Parisi V, Centofanti M, Ziccardi L, Tanga L, Michelessi M, Roberti G, Manni G. Treatment with Citicoline eye drops enhances retinal function and neural conduction along the visual pathways in open angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2015 Aug;253(8):1327-40. https://doi.org/10.1007/s00417-015-3044-9
9. Заволока ОВ, Бездітко ПА, Луханін ОО. Ефективність нового пристрою для безконтактної діагностики чутливості рогівки при визначенні її нейротрофічного стану у хворих на цукровий діабет I типу та бактеріальний кератит. Офтальмол. журн. 2019;6:29-33. Zavoloka OV, Bezditko PA, Lukhanin OO. [Effcacy of a novel non-contact corneal esthesiometer in assessing the neurotrophic status of the cornea in T1DM patients with bacterial keratitis]. J. ophthalmol. 2019 Dec;6:29-33. Ukrainian. http://doi.org/10.31288/oftalmolzh201962933
10. Гайдамака ТБ. Рецидивирующий герпетический кератит. Патогенез, диагностика, лечение, профилактика [дисс. … док. мед. наук : 14.01.18]. Одесса; 2011. Gaydamaka TB. [Recurrent herpetic keratitis. Pathogenesis, diagnosis, treatment, prevention [dissertation]. Odesa: The Filatov Institute of Eye Diseases and Tissue Therapy of the Academy of Medical Sciences of Ukraine; 2011. Russian.
11. Acharya M, Farooqui JH, Jain S, Mathur U. Pearls and paradigms in Infective Keratitis. Rom. J. Ophthalmol. 2019;63(2):119–27.

Received: 2020 Apr 14
Published: October 2020